The etiology of cardiomyopathy in general, and alcoholic cardiomyopathy in particular is poorly understood. The "moonshine" drinker in the Southeast and other areas of the country may be exposed to injuries from not only alcohol, but contaminants such as lead and other heavy metals in trace quantities. Therefore, a study of hemodynamic and metabolic variables was performed on patients with cardiomyopathy with or without history of alcoholism. Lead and other trace metals were sought in the coronary sinus blood before and after chelation and the role of these in the pathogenesis of the syndrome was examine. Left ventricular performance before and after chelation was also studied and related to the results of the metabolic data. Similar patients without evidence of cardiomyopathy but with conventional criteria, who were exposed to these toxins, were studied to understand hemodynamic and metabolic changes in hearts afflicted with this problem early in the natural history. To support the findings in the humans, parallel study has been conducted with small animals exposed to a variety of myocardial toxins such as alcohol, trace metals, etc. Cellular and sub-cellular variations were analyzed by electron microscopy and by tissue analysis for various electrolytes. A program of chronic chelation in patients with evidence of subclinical or clinical toxicity from any of these trace metals, is underway to see whether such treatment has benefical effects in the natural history of their heart such treatment as any beneficial effects in the natural history of their heart disease. Findings so far suggest that there is some improvement in the hemodynamic performance of the heart in patients not with acute chelation but chronic chelation as well. Data, however, should be judged with caution since this only represents preliminary work.